Talk:Archive:Healing Arts Workgroup

(Porting this over as a start) Maybe a picture will help. On the right, you have (red) medicine, with a theoretical underpinning of biomedical sciences. Some of conventional medicine makes it through the filter of evidence-based medicine, and combines into orange: the best common practice of standalone conventional medicine. Some of conventional medicine doesn't have supporting evidence and as much quackery as the wildest alt theory.

Now, to the left, you have five boxes, not the neatest grouping but based on the NCCAM taxonomy. Alternative or whole systems, by definition, deal with all the healthcare needs of an individual and don't want to work with any other discipline. Perhaps the least controversial example would be a form of spiritual therapy that wants absolutely nothing but prayer, or sacrificing goats, or whatever. By its very definition, alternative medicine is alternative to everything else, and isn't going to be complementary or integrative.

To the right, there are four boxes of categories of technique. Now, there's no good way to draw something I'll explain: a given technique may be used in alternate medicine, or it might be used in complementary medicine. Complementary means "willing to play nicely with other disciplines".

Some blue complementary theories make it through the EBM filter and become light green. Bright green Integrative medicine is the combination of complementary and mainstream techniques, working together, which all meet varying standards for evidence-based medicine.

Each technique has verying levels of theory. Just like some conventional medicine doesn't make it through EBM and is quackery, some of the CAM techniques drop down and go quack-quack too.

My suspicion is that there's no one plausible theory article for CAM, any more than there's really common theory between the mechanical requirements of a replacement hip joint and the biochemical treatment of schizophrenia. The four types of CAM, to some extent, do have some commonality, although the assumptions of one energy technique, such as acupuncture , are very different from those of reflexology, and the specific discipline theory will be in the discipline-specific article.

There are cases where a given type of practitioner uses more than one class. For example, Traditional Chinese Medicine practioners use, among other things, herbals and acupuncture.

The team approach in integrated medicine can use all of the EBM-approved techiques. For some complementary techniques, the level of risk is so low, they don't interfere with other techniques, and are cheap enough that they don't need the same level of evidence as something more dangerous/interfering/costly. Howard C. Berkowitz 23:45, 29 December 2008 (UTC)

Is this nice picture to help us here at talk or are you proposing some version of it for the article? If the latter, I would say emphatically NO. It's not intuitive, and, I would say, it's almost certainly Original Research.... (If it takes 500 words to explain a diagram, then it's not worth using. Hayford Peirce 01:39, 30 December 2008 (UTC)

For Talk, specifically addressed to Larry's questions about how articles fit together. I would put it as a challenge to anyone thinks there is a meaningful single theory of alt med: where does it go, given all these other pieces are reasonably well defined? What theory, for example, would be common to reflexology, acupuncture, reiki, and therapeutic touch, beyond a generic "they all involve energy". Howard C. Berkowitz 02:00, 30 December 2008 (UTC)

Though arguments could be made concerning the locations and sizes of the boxes, the jist of diagram is pretty close; that Howard shows a good understanding of the problem, which is halfway to the solution. Why don't we consider bringing this to the workgroup page where we can document the process and at the same time develop the plan for all the Healing Arts articles, not just this one. Then maybe this one will fall into place. D. Matt Innis 02:04, 30 December 2008 (UTC)

Don't read anything into the size of the boxes -- some are that way just because it was a quick way to get the necessary text into the boxes without changing fonts, or to have certain color changes (i.e., blue passing through yellow becomes green, red passing through yellow becomes orange). And yes, green and orange, as I think of it, should have been brown. I'll be happy to take comments and fix it up, but that was 15 minutes of PowerPoint, not a more powerful graphics package or hand-drawn and scanned.

Having a workgroup discussion is a great idea. Some of you may know this, but the first chapter of each monograph I've written has the same title: "what problem are you trying to solve.". Matt, have you an idea on how to start this? I have been trying to get simple definitions of the alt disciplines, many just stubs. I am fairly happy with integrative medicine, but if there's a better way, I won't lose sleep. If I lose weight, tell me more. :-)

Matt, do you want a copy of the PowerPoint original? Howard C. Berkowitz 02:45, 30 December 2008 (UTC)

Matt, have you an idea on how to start this? I have been trying to get simple definitions of the alt disciplines, many just stubs. I am fairly happy with integrative medicine, but if there's a better way, Well, I'm pretty sure that if we put you on the NCCAM board of directors, you could work this out fairly quickly. The problem is that the rational approach won't necessarily define the circular reality. I am convinced that governments have combined complementary and alternative approaches because they cannot be reasonably separated cleanly. We can define the terms as 'alternative' and 'complementary', but it is unlikely that we can place anything cleanly in a particular bracket. Then, I agree, we can relate the degree of alternative or complementary a practice can be in their own articles. Integrative is just the cutting edge description for those practises that consumer demand is causing conventional medicine to evaluate and incorporate into their paradigms.

Sure, send me the Powerpoint original and if something hits me that I can improve, I'll send it back.

D. Matt Innis 03:34, 30 December 2008 (UTC)

By the way, I still think these should be contained in one article Complementary and Alternative medicine and I actually look forward to linking to an article on the the early history of the philosophy of medicine because it is also the history of the philosophy of alternative medicine as well. D. Matt Innis 03:43, 30 December 2008 (UTC)

Integrative vs. the others

To some extent I agree, and to some extent I disagree, with the idea that CAM can't be separated. There is a set of techniques that may or may not meet requirements of evidence-based medicine. By that, I don't necessarily mean randomized controlled trial; the British Parliamentary report is quite good on addressing other forms of evidence.

The World Health Organization is starting to use the term "traditional, complementary and alternative", which confuses things even more. I'm still chuckling over a situation where a hospital, which considered itself very flexible, was doing everything it could to make a Lakota Sioux patient feel cared-for, which included giving full respect to a tribal healer working with them. There was a genuine humility and interest on all sides. Things, unfortunately, rather hit the fan, when the hospital, which had a draconian no-smoking policy, discovered that the ritual used tobacco. Eventually, they just said "turn off the oxygen, wait a while for the bedding to equilibriate with room air, and then just close the door during the rite."

The principal difference I see in complementary and alternative is not, by and large, in the techniques. It is a willingness to work with other disciplines. For example, a spiritual healer that is willing to be involved if and only if prayer is the only modality used is alternative. I have, incidentally, fired MDs that variously were not willing to get second opinions in their specialties, or opinions in another relevant specialty, or honor my informed consent or refusal to something they wanted.

Alternative, to me, means a failing mark in "plays nicely with others". Complementary means "there are multiple ways. Let's see if we can work together." Integrative is an agreement for a real group of assorted practitioners to sit down and figure out where they can help one another, and, of course, the patient.

I guess I don't look at "consumer demand" as a factor. Howard C. Berkowitz 04:35, 30 December 2008 (UTC)

Traditional are those practices that are indigenous to a region, i.e. herbs to the Navajo tribes, etc.. Conventional as we see it is not always traditional in every country that the WHO oversees. Because they are also a political organization, they have chosen this way to include the various beliefs that exist in undeveloped worlds as well.

In many ways, medicine was not 'playing well with others' in not recognzing them as legit forms of therapy until the 1983 Wilks Antitrust suit in which they were no longer allowed to boycott chiropractic. So, again, it depends on your perspective as to who is playing nicely with whom. Most of these professions, including chiropractic developed educational systems independent of medicine in order to be able to continue to practice their disciplines. As new and more creative ways of researching began in the 1970s, spinal manipulation began to show promise for low back pain, but it wasn't until the 1990s when the US government came out with guidelines for the treatment of low back pain that had spinal manipulation as one of the top choices (and more significantly that surgery was overused) that medicine had a wake up call. In the late 1990s, the report surfaced that americans were spending more on alternative medicines out of pocket than payments to primary care. If one accepts that alternative medicine is placebo effect, then the motivation to integrate alternative medicine into conventional medicine must have been market driven - consumer driven rather than science based. Otherwise, you accept that the placebo effect is more than just doing nothing and it would be a legitimate practice. D. Matt Innis 05:08, 30 December 2008 (UTC)